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©2014 Baishideng Publishing Group Inc.
World J Gastroenterol. Jun 14, 2014; 20(22): 6786-6808
Published online Jun 14, 2014. doi: 10.3748/wjg.v20.i22.6786
Published online Jun 14, 2014. doi: 10.3748/wjg.v20.i22.6786
Table 1 Characteristics of some colorectal cancer screening programs worldwide
Country | Test | Periodicity | Target population (age) | Year2 |
Germany1 | FOBT | Annual | 50-54 | 1971 |
FOBT or CS | Biennial/Every 10 yr | ≥ 55 | ||
Italy | FOBT | Biennial | 50-69/74 | 1982 |
FS | Once-only | 58-60 | ||
Israel | FOBT | Annual | 50-74 | early 1990s |
Japan | FOBT | Annual | ≥ 40 | 1992 |
United States1 | FOBT | Annual | 50-75 | 1994 |
FS/FOBT | Every 5/Every 3 yr | |||
CS | Every 10 yr | |||
Taiwan | FOBT | Biennial | 50-69 | 1995 |
Spain | FOBT | Biennial | 50-69 | 2000 |
Poland1 | CS | Periodic | 50-66 | 2000 |
Czech Republic1 | FOBT | Annual | 50-54 | 2000 |
FOBT/CS | Biennial/Every 10 yr | ≥ 55 | ||
France | FOBT | Biennial | 50-74 | 2002 |
Finland | FOBT | Biennial | 60-69 | 2004 |
South Korea | FOBT | Annual | ≥ 50 | 2004 |
Latvia1 | FOBT | Annual | ≥ 50 | 2005 |
Australia | FOBT | Biennial | 55-74 | 2002 |
England | FOBT | Biennial | 50-74 | 2006 |
The Netherlands | FOBT | Biennial | 60-69 | 2006 |
Canada | 2007 | |||
Ontario | FOBT | Biennial | ≥ 50 | |
Manitoba | FOBT | Biennial | 50-74 | |
Croatia | FOBT | Biennial | 50-74 | 2007 |
Scotland | FOBT | Biennial | 50-74 | 2007 |
Sweden | FOBT | Biennial | 60-69 | 2008 |
Table 2 Main colorectal cancer screening tools
Test | Sensitivity | Specificity | Considerations |
Colonoscopy | 90% | It requires a bowel cleansing preparation and sedation. | |
Adenoma ≤ 5 mm | 70%-79% | Risk of severe complications. | |
Adenoma 6-9 mm | 80%-92% | Not well accepted by population. | |
Adenoma ≥ 10 mm | 92%-99% | ||
CRC | 92%-99% | ||
Sigmoidoscopy1 | 92% | It requires less preparation. | |
Adenoma ≤ 5 mm | 70%-79% | Sedation it is not necessary. | |
Adenoma 6-9 mm | 80%-92% | Proximal lesions are not detected | |
Adenoma ≥ 10 mm | 92%-99% | ||
CRC | 90%-92% | ||
gFOBT standard | 95%-99% | Dietary and pharmacological interactions. | |
Adenoma ≤ 5 mm | 1%-5% | 3 samples | |
Adenoma 6-9 mm | 5%-13.7% | ||
Adenoma ≥ 10 mm | 8.9%-27.5% | ||
CRC | 25%-50% | ||
gFOBT sensitive | 90%-95% | Dietary and pharmacological interactions. | |
Adenoma ≤ 5 mm | 5%-10% | 3 samples | |
Adenoma 6-9 mm | 10%-26.2% | ||
Adenoma ≥ 10 mm | 17.7%-49.4% | ||
CRC | 50%-87% | ||
FIT | 92.5%-98% | The sample needs to be refrigerated. | |
Adenoma ≤ 5 mm | 2%-7.5% | ||
Adenoma 6-9 mm | 7.5%-24.0% | ||
Adenoma ≥ 10 mm | 16%-48% | ||
CRC | 50%-87% |
Table 3 Fecal DNA markers for advanced adenoma and colorectal cancer n (%)
Marker | Study | Sensitivity | Specificity | |
CRC | Adenoma > 1 cm | |||
Meth vimentin | Chen et al[166] | 43 (46) | - | 178 (90) |
Itzkowitz et al[167] | 29 (73) | - | 106 (89) | |
Li et al[168] | 9 (41) | 9 (45) | 63 (95) | |
Meth SFRP2 | Huang et al[169] | 49 (94) | 11 (53) | 23 (96) |
Wang et al[170] | 60 (87) | 21 (62) | 28 (93) | |
Meth TFPI2 | Glöckner et al[171] | 36 (76) | 4 (21) | - |
Meth ITGH4 | Ausch et al[172] | - | 9 (69) | 22 (79) |
Meth Spastic paraplegia-20 | Zhang et al[173] | 77 (80) | - | 30 (100) |
Meth PHACTR3 | Bosch et al[174] | (50-60) | (17-29) | (92-98) |
Meth TFPI2, long DNA | Zhang et al[175] | 52 (87) | 4 (44) | 25 (83) |
APC, KRAS, p53, long DNA | Imperiale et al[102] | 16 (52) | 84 (12) | 1344 (94) |
APC, KRAS, p53, long DNA | Alhquist et al[103] | 3 (25) | 47 (8) | 2246 (96) |
APC, KRAS, Meth vimentin | Alhquist et al[103] | 11 (58) | 55 (45) | 63 (84) |
Meth SFRP2, HPPI, MGMT | Huang et al[169] | 50 (96) | 15 (71) | 23 (96) |
Meth APC, ATM, hMLH1, sFRP2, HLTF, MGMT, and GSTP1 | Leung et al[176] | 15 (75) | 17 (68) | 27 (90) |
Meth vimentin, long DNA | Itzkowitz et al[167] | 68 (83) | 6 (86) | 298 (82) |
Meth RASSF2 or SFRP2 | Nagasaka et al[177] | 63 (75) | 25 (44) | 101 (89) |
Meth BMP3, hDNA, KRAS, APC | Zou et al[100] | 67 (91) | 21 (78) | 85 (85) |
Meth vimentin, MLH1, MGMT | Baek et al[178] | 45 (75) | 31 (60) | 32 (87) |
Meth RARB2, p16INK4a, MGMT, APC | Azuara et al[179] | 16 (62) | 8 (40) | 20 (100) |
KRAS, a actina Meth NDRG4, BMP3, vimentin, TFPI2 | Ahlquist et al[107] | 214 (85) | 72 (54) | 264 (90) |
β-actin, KRAS, meth BMP3 and NDRG4, fecal hemoglobin | Lidgard et al[105] | 91 (98) | 48 (57) | 139 (90) |
Table 4 Fecal RNA markers for colorectal adenoma and colorectal cancer n (%)
Marker | Sample | Study | Sensitivity | Specificity | |
CRC | Adenoma | ||||
CDA, MGC20553, BANK1, BCNP1, MS4A1 | Blood | Han et al[138] | 30 (88) | - | 27 (64) |
ANXA3, CLEC4D, LMNB1, PRRG4, TNFAIP6, VNN1, IL2RB | Plasma | Marshall et al[180] | 145 (72) | - | 146 (70) |
ANXA3, CLEC4D, TNFAIP6, LMNB1, PRRG4, VNN1, IL2RB | Plasma | Yip et al[181] | 60 (61) | - | 85 (77) |
MicroRNA (miRNA-21, miRNA-106a) | Fecal | Link et al[113] | (74) | - | (79) |
MicroRNA-L6 | Plasma | Schiedeck et al[182] | 145 (79) | - | 45 (100) |
MicroRNA (miRNA-92) | Plasma | Ng et al[142] | 80 (89) | - | 35 (70) |
MicroRNA (miRNA-92a, miRNA-21) | Fecal | Wu et al[183] | 63 (72) | 32 (56) | 74 (73) |
ANXA3, CLEC4D, LMNB1, PRRG4, TNFAIP6, VNN1, IL2RB | Plasma | Chao et al[184] | 215 (78) | - | 215 (66) |
COX2, matrix metalloproteinase 7 | Fecal | Takai et al[111] | 56 (90) | - | 29 (100) |
Table 5 Serum DNA markers for adenoma and colorectal cancer n (%)
Marker | Study | Sensitivity | Specificity | |
CRC | Adenoma | |||
APC, KRAS, p53 | Wang et al[185] | 36 (46) | - | 50 (100) |
APC mutation | Diehl et al[121] | 16 (73) | 1 (9) | 33 (100) |
APC, MLH1, HLTF | Leung et al[186] | 3-28 (6-57) | - | 37-41 (90-100) |
Meth SEPT9 | Lofton-Day et al[134] | 92 (69) | - | 154 (86) |
Grützmann et al[133] | 73 (58) | 3 (18) | 165 (90) | |
deVos et al[131] | 62 (69) | - | 132 (89) | |
Tóth et al[187] | 88 (96) | - | 78 (85) | |
TMEF2, NGFR, SEPT9 | Lofton-Day et al[134] | 40-69 (30-52) | - | 170 (95) |
Meth on 10 genes | Lee et al[188] | 210 (87) | 48 (75) | 254 (92) |
Meth Vimentin | Li et al[168] | 48 (59) | - | 102 (93) |
Table 6 TNM classification of colorectal cancer
T = Primary tumor |
TX = Primary tumor cannot be assessed |
T0 = No evidence of primary tumor |
Tis = Carcinoma in situ: intraepithelial or invasion of lamina propria |
T1 = Tumor invades submucosa |
T2 = Tumor invades muscularis propria |
T3 = Tumor invades through the muscularis propia into subserosa or into nonperitonealized pericolic or perirectal tissues |
T4a = Tumor penetrates to the surface of the visceral peritoneum |
T4b = Tumor directly invades or is adherent to other organs or structures |
N = Regional lymph nodes |
NX = Regional lymph nodes cannot be assessed |
N0 = No regional lymph node metastasis |
N1a = Metastasis in one regional lymph node |
N1b = Metastasis in two to three regional lymph nodes |
N1c = Tumor deposit(s) in the subserosa, mesentery, or nonperitonealized pericolic or perirectal tissues without regional nodal metastasis |
N2a = Metastasis in four to six regional lymph nodes |
N2b = Metastasis in seven or more regional lymph nodes |
M = Distant metastasis |
MX = Distant metastasis cannot be assessed |
M0 = No distant metastasis |
M1a = Distant metastasis to one organ or site |
M1b = Distant metastasis to more than one organ/site or the peritoneum |
Staging |
Stage I (T1-T2, N0, M0) |
Stage IIA (T3, N0, M0) |
Stage IIB (T4a, N0, M0) |
Stage IIC (T4b, N0, M0) |
Stage IIIA (T1-T2, N1, M0 and T1, N2a, M0) |
Stage IIIB (T1-T2, N2b, M0; T2-T3, N2a, M0 and T3-T4a, N1, M0) |
Stage IIIC (T3-T4a, N2b, M0 and T4b, N1-N2, M0 and T4a, N2a, M0) |
Stage IVA (any T, any N and M1a) |
Stage IVB (any T, any N and M1b) |
Table 7 Systemic treatment of colon cancer
Adjuvant therapy (stage III and stage II with high-risk features for systemic recurrence) |
FOLFOX |
CapeOx |
If oxaliplatin is contraindicated or elderly patients |
Capecitabine |
5-FU/Leucovorin |
Metastatic disease (stage IV) |
Resectable disease (lung, hepatic or peritoneal metastasis) |
Consider surgery and/or locoregional treatment (radiofrequency, stereotactic radiotherapy) and 6 mo of perioperative chemotherapy (FOLFOX, CapeOx preferred) |
Potentially resectable |
FOLFOX |
FOLFIRI |
FOLFOXIRI |
Cetuximab + FOLFIRI (only KRAS wild type) |
Panitumumab + FOLFOX (only KRAS wild type) |
Bevacizumab + FOLFOX |
Unresectable (palliative) |
FOLFOX |
CapeOx |
FOLFIRI |
FOLFOX + Bevacizumab |
CapeOx + Bevacizumab |
FOLFOX + Panitumumab (only KRAS wild type) |
FOLFIRI + Panitumumab (only KRAS wild type) |
FOLFIRI + Cetuximab (only KRAS wild type) |
FOLFIRI + Aflibercept |
Capecitabine |
5-FU/Leucovorin |
Cetuximab + Irinotecan (only KRAS wild type) |
Cetuximab monotherapy (only KRAS wild type) |
Panitumumab monotherapy (only KRAS wild type) |
Regorafenib |
- Citation: Binefa G, Rodríguez-Moranta F, Teule &, Medina-Hayas M. Colorectal cancer: From prevention to personalized medicine. World J Gastroenterol 2014; 20(22): 6786-6808
- URL: https://www.wjgnet.com/1007-9327/full/v20/i22/6786.htm
- DOI: https://dx.doi.org/10.3748/wjg.v20.i22.6786